Guillain-barré syndrome without limb weakness: A rare variant with acute bulbar palsy

A 76-year-old male was brought to the emergency room with an acute onset of breathlessness and difficulty swallowing. Examination revealed bilateral ptosis, bilateral vocal cord abductor palsy with diaphragmatic paralysis. He did not have any limb weakness. A diagnosis of acute bulbar palsy was made. Cerebrospinal fluid showed albumino-cytological dissociation. Magnetic resonance imaging of the brain (MRI) was normal, and a nerve conduction study (NCS) showed Acute Motor and Sensory Axonal Neuropathy (AMSAN). Guillain-Barré syndrome with acute bulbar palsy was considered. Here, we report a case of suspected Acute Bulbar Palsy plus (ABPp) syndrome. ABPp may be considered as a variant of GBS between the Miller-fisher and Pharyngeal-cervical-brachial variant and does not have any definite limb weakness. This patient also had ABPp with diaphragmatic palsy. However, whether this syndrome is an isolated variant of GBS or a continuum between the Miller-fisher syndrome (MFS) and Pharyngo-cervical brachial (PCB) variants remains to be elucidated. This case is relevant to primary care physicians as the disability with GBS remains high and may render a large burden to carers. The initial symptom of acute dysphagia must lead on the primary care physician to keep this disease in mind to prevent an unwarranted delay in diagnosis.